| NPI | 1669851424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: KY 55433) |
| Additional Taxonomies | 2085R0001X (Licence: IN 01085991A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0005616) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2021-07-22 |